Form Uct-673-E - Nonprofit Organization Employer'S Report - 2014
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1
2NONPROFIT ORGANIZATION
This is a fill-in form. Please click on the appropriate area to enter information. Tab between fields and PRINT when completed.
Complete 1-5 If different from address at left,
2014
EMPLOYER'S
REPORT
FOR
then go to #6:
Required
to
determine
your
employer
status
under
the
Wisconsin
Unemployment
Insurance
Act,
(CHAPTER
108,
1. Legal Name
WIS.
STATS.)
COMPLETE
AND
RETURN
THIS
REPORT
WITHIN
10
DAYS,
UNLESS
INSTRUCTED
OTHERWISE,
EVEN IF THERE ARE NO EMPLOYEES.
UI ACCOUNT NUMBER
2. Trade Name
3. Mailing Address
c/o
(If
required
for
correct
delivery)
4. Street or P.O. Box
5. City
State
Zip Code
6. Federal Identification Number (9 digits)
7. Person To Contact For Additional
information:
Name/Email Address
Send to:
Department of Workforce Development
Division of Unemployment Insurance
P.O. Box 7942
Madison, Wisconsin 53707-7942
Telephone Number
Telephone: (608) 261-6700
FAX: (608) 267-1400
(
)
email: taxnet@dwd.wisconsin.gov
9. Number of
employees on payroll:
8. Date you first had paid employees in Wisconsin (Mo/Day/Yr):
Nonprofit
organizations
are
required
to
comply
with
the
Wisconsin
Unemployment
Insurance
Law
as
of
10.
the
beginning
of
any
calendar
year
if
they
employed
at
least
4
individuals
on
at
least
one
day
in
20
different
calendar
weeks
in
either
the
current
or
preceding
calendar
year.
Section
108.02(19)
defines
a "nonprofit organization" as an organization described in s.501(c)(3) of the Internal Revenue Code.
Is your organization a nonprofit organization?
Yes
No
If
"yes,"
you
must
submit
a
copy
of
your
determination
letter
from
the
Internal
Revenue
Service,
establishing
your
nonprofit
status,
if
you
have
not
already
done
so.
If
you
have
not
received
your
501
(c)(3)
ruling,
submit
a
copy
of
your
application
for
501
(c)(3)
status
and
a
copy
of
your
articles
of
incorporation.
(Failure
to
submit
a
copy
will
mean
your
organization
cannot
be
treated
as
a
nonprofit
organization for purposes of the Wisconsin U.I. Law.)
11.
Did
you
have
4
or
more
employees
working
for
you
on
the
same
day
in
20
different
weeks
in
a
calendar year? (Do not include employees working in excluded employment.)
If yes, what was the date the 20th week ended (mo/day/yr)?
_______
12. Briefly describe the services provided by your organization:
13. Location where the organization conducts business if different from mailing address:
CONTINUE
UCT-673-E
(R.
11/25/2013)
(U00606)
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